“I felt thoroughly inadequate. I didn’t feel like I was attractive enough. I didn’t feel like I was doing enough. Nobody told me I could feel that way” — Patience, Post Partum Depression Survivor

Patience (not her real name) a new mother of one, and a university-educated professional, said that when she gave birth, she had expected to feel only joy and fulfillment at the arrival of her first child. The reality was very different. After she gave birth, she says, “I started asking myself, ‘Is this (childbirth) all I’m good for? I’ve had a baby, I’m supposed to be ecstatic — at least that is what we are made to believe. I didn’t feel fulfilled. I went through an identity crisis. I struggled a lot with suicidal thoughts. I would think of killing myself all the time. It was really horrible.”

For a number of women all over the world,like Patience, the often exhilarating experience of childbirth is followed by sadness, fear, anxiety, mood swings and decreased sexual desire. In Patience’s case, out of curiosity and to be armed with as much information as she could, during her pregnancy, she searched online for almost everything she could find that prepare her for what to expect during her pregnancy. Yet, nowhere in her extensive online research and her antenatal classes, did she have any idea about postpartum depression or the possibility that it might be something she would struggle with after she gave birth.

Patience’s case is apparently not unusual. According to the World Health Organisation (WHO), about 20% of mothers in developing countries experience depression after childbirth. WHO recommends that at each postnatal contact with health workers, mothers should be asked about their emotional wellbeing, what family and social support they have and their usual coping strategies for dealing with day-to-day matters.

This was not the case for Patience. “The only medical appointment for me after birth was in six weeks and that checkup was physical. They checked that I was healing and asked about bleeding. Nobody asked how I felt,” she said.

Image credit: Nigeria Health Watch

Struggling to breastfeedIt has become commonplace for health workers to strongly urge new mothers to exclusively breastfeed for the first six months of a newborn’s life, given the many health benefits that research evidence has shown that this provides. However, often mothers are not really prepared for how challenging it can sometimes be. Neither are they often provided with practical information on what to do if they find themselves in circumstances that could make exclusive breast difficult or impossible, such as a short maternity leave period, having inverted nipples or depression to name a few challenges that new mothers face.

In Patience’s case, all her dreams to exclusively breastfeed fell apart, as she had inverted nipples and couldn’t breastfeed until three days after the delivery of her baby. Until she could breastfeed, her baby survived on only water. “During antenatal, the health workers glossed over breastfeeding. I was not told how to breastfeed or what to do if I can’t breastfeed,” she said, adding that, “I had planned to bond with my baby by exclusively breastfeeding for six months and all of a sudden, I was confronted with a hungry newborn who I couldn’t feed because I found out I had inverted nipples. That experience made me very sad and depressed.”

A recent Nigeria Health Watch article highlighted the importance of compassion from health workers when caring for new mothers who were struggling to breastfeed.

Affordability remains a problem in healthcarePatience said she was diagnosed with three fibroid tumors outside her womb during one of her antenatal visits. The egg yolk-sized fibroids were removed during her delivery, which was via caesarean section. “The removal of the fibroids and the C-section were costed as two different surgeries whereas they opened me only once. I tried to contest it, but I was told that it was the hospital policy. My bill was over 1 million Naira,” she said.

The cost of the surgery further plunged her into depression from the financial burden. She said her office policy was to cover 90% of an employee’s medical bills, but until she had the surgery she did not know that the policy had a cap after which the office would no longer provide coverage. “Once it crosses that cap, you pay the balance. So because the bill was over a million naira, they paid NGN300,000 and I paid the rest over one year,” she said. In addition to her struggles breastfeeding she bore a majority of her hospital bills.

Finding work/life balance Work-life balance is trying for most working mothers, but it can be particularly consuming for new mothers. In 2018, the Minister of Labour and Employment, Dr. Chris Ngige, announced the extension of maternity leave from 12 to 16 weeks.

However, in many Nigerian organisations, staff are entitled to only three months of maternity leave. The situation is not any better where Patience works, an international humanitarian organisation. “I stayed at home for four months; three months maternity leave and one month annual leave,” she said. And when she got back to work, “There was no conducive environment for breastfeeding mothers. There was no room to pump breastmilk and I had to pump in my colleague’s office who was just being nice. We eventually pushed for a space but it doubles as the room for medical checkup. It is not officially a breastfeeding room,” she said.

Work-life balance is trying for most working mothers, but it can be particularly consuming for new mothers. Photo credit: Nigeria Health Watch

It is important that employers provide clean and private spaces (not toilets) for mothers to breastfeed and express milk during office hours.

Dealing with breastfeeding struggles, the financial burden of her surgery and trying to find her balance with work were issues that overwhelmed Patience and contributed to her feelings of depression. Eventually, she was able to put some things in place to help her come out of the condition. She took away some important nuggets from her experience which we share here in her own words:

Talk it out: “It took me a while to confide in my friend about how I felt. While pumping breastmilk in the store, I would stay there and cry and say everything I was feeling. If you can afford help, please do. There are online platforms where you can speak to professional counselors. Just find someone to talk to. I did and it helped”.

Find something you are passionate about: “It is very easy to lose yourself in that period. I used to exercise a lot, but with the c-section, I couldn’t do that for a while — another reason I felt depressed. I had to find indoor exercises I could do. Just do something that makes you happy and focus on it”.

Be patient: “Having a baby changes your entire life. It takes time to adjust mentally, emotionally and physically. There is so much pressure to ‘snapback’ to your former body. It can be very depressing especially when you are trying to love your new body. Get off social media if you need to. The pressure is real.”

Get strong support: “My husband tried to support in his own way. However, I feel that some husbands are not as hands-on as they should be. They are disassociated from the fact that two of you made the baby and the baby requires work from both of you. They expect you to take care of them, the baby and yourself at the same time. Also, it is not ‘omugwo’ when the woman coming to help you doesn’t do anything and needs to be taken care of too. Accept the fact that you can’t do it all and ask for help from people.”

Society pushes a narrative that when it comes to childbirth and caregiving, women are supposed to be strong, literally ‘carry the world on their shoulders’ and not complain. Photo credit: Nigeria Health Watch

The fear of being judged by others, especially in a society like ours where motherhood is venerated, and mental health issues are stigmatised, perpetuates a culture of silence in women when they need to speak up about issues like postpartum depression. Society pushes a narrative that when it comes to childbirth and caregiving, women are supposed to be strong, literally ‘carry the world on their shoulders’ and not complain. These societal expectations, sometimes even prevalent among health workers as described in this piece in Granta Magazine, People Don’t Get Depressed in Nigeria by our team member, Ike Anya, puts incredible pressure on women, worsening an already challenging period of life changes that the unique experience of a new child brings. Given the hidden cost of these expectations, it is time for us as a society to begin to talk about and act on postpartum depression and the other pressures and expectations put on women during and after childbirth, in order to break through the stigma and misconception.

Postpartum depression is not a mother’s fault. New mothers should have access to the support structures that enable them to ask for help if they are struggling emotionally. Health workers and family members should enlighten women and their partners in the antenatal period about the potential challenges that they might face post-childbirth and how to deal with them. In addition, health workers should be alert and sensitive when looking to spot the symptoms of postpartum depression and other challenges and they need to be ready to offer help to new mothers.

Even though postpartum depression is a serious condition, it can be addressed and many women like Patience have recovered from it, thankfully without it evolving into more serious consequences. As Nigerians, we can help make this better if we are more aware, able to let these women talk, be ready to listen and respond in a supportive way and ensure that they have access to help and that the help is available and effective.

Have you or someone you know ever experienced postpartum depression? Where did you or they seek support? Share your experience with us in the comments section or on our social media platforms.